Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $30.00 / $37.50 / $445.60	Facility		$30.00	$37.50	$445.60
Aetna Facility/Professional Facility Modifier QK Low / Median / High Price $159.12 / $159.12 / $813.28	Facility	QK	$159.12	$159.12	$813.28
Aetna Facility/Professional Facility Modifier QX Low / Median / High Price $131.04 / $430.52 / $669.76	Facility	QX	$131.04	$430.52	$669.76
Aetna Facility/Professional Professional Modifier AA Low / Median / High Price $242.59 / $708.11 / $1,008.53	Professional	AA	$242.59	$708.11	$1,008.53
Aetna Facility/Professional Professional Modifier QK Low / Median / High Price $99.00 / $396.97 / $596.66	Professional	QK	$99.00	$396.97	$596.66
Aetna Facility/Professional Professional Modifier QX Low / Median / High Price $121.30 / $434.52 / $869.05	Professional	QX	$121.30	$434.52	$869.05
Aetna Facility/Professional Professional Modifier QY Low / Median / High Price $94.50 / $359.55 / $502.08	Professional	QY	$94.50	$359.55	$502.08
Aetna Facility/Professional Professional Modifier QZ Low / Median / High Price $259.20 / $340.20 / $650.72	Professional	QZ	$259.20	$340.20	$650.72
Ambetter Facility/Professional Professional Modifier AA Low / Median / High Price $98.90 / $98.90 / $212.44	Professional	AA	$98.90	$98.90	$212.44
Ambetter Facility/Professional Professional Modifier QK Low / Median / High Price $53.16 / $83.08 / $256.00	Professional	QK	$53.16	$83.08	$256.00
Ambetter Facility/Professional Professional Modifier QX Low / Median / High Price $70.20 / $88.52 / $192.00	Professional	QX	$70.20	$88.52	$192.00
Ambetter Facility/Professional Professional Modifier QY Low / Median / High Price $106.81 / $265.00 / $318.00	Professional	QY	$106.81	$265.00	$318.00
Ambetter Facility/Professional Professional Modifier QZ Low / Median / High Price $98.90 / $127.58 / $306.00	Professional	QZ	$98.90	$127.58	$306.00
BCBS Facility/Professional Professional Modifier AA Low / Median / High Price $105.00 / $175.50 / $255.54	Professional	AA	$105.00	$175.50	$255.54
BCBS Facility/Professional Professional Modifier QX Low / Median / High Price $29.67 / $52.50 / $113.43	Professional	QX	$29.67	$52.50	$113.43
BCBS Facility/Professional Professional Modifier QZ Low / Median / High Price $84.00 / $120.00 / $181.50	Professional	QZ	$84.00	$120.00	$181.50
Medcost Facility/Professional Facility Modifier Low / Median / High Price $30.00 / $1,950.00 / $3,000.00	Facility		$30.00	$1,950.00	$3,000.00